Fragmented, Affordable Healthcare in Argentina

By Leslie Quinn, MBA, Program Coordinator

My name is Leslie Quinn, and I have been a Program Coordinator at The Center for three years. I recently took two weeks off to complete a capstone project for my Master of Business Administration (MBA) program at the College of St. Scholastica. The capstone was a study-abroad seminar in Buenos Aires, Argentina to observe and engage in cross-cultural and global business settings.

The population of Argentina is 42.6 million; one-third of which resides in Buenos Aires. Argentina is an urban country with only 7.3 percent of the population residing in rural areas. It is one of the Latin American countries that spends the most on healthcare. In 2012, Argentina spent 8.5 percent of gross domestic product (GDP) on total health expenditures. The healthcare system in Argentina is comprised of three sectors: private, social and public. The private sector covers about 10 percent of the population, social covers about 50 percent, and the public sector covers about 40 percent. There is no national health system; it is the responsibility of the provinces.

Every citizen has the right to healthcare in Argentina. If they can’t afford insurance, they receive free care in the public sector. To get an appointment, you must go early in the morning, take a number and wait. The system allows foreigners to receive free care also. Medical tourism is a growing industry as people from industrialized countries seek lower cost care elsewhere.

On my last Delta flight I saw an advertisement for Medical Tourism in Argentina in the SKY magazine

Social

There are two defined structures within the social sector: Obras Sociales Provinciales (OSPs) and Obras Sociales Nacionales (OSNs). There is one OSP for each of the 23 provinces in Argentina and the autonomous city of Buenos Aires. The OSPs provide coverage for civil servants; around 5 million public sector employees and their dependents are covered through the OSPs. There are over 300 OSNs, which are managed by trade unions. We visited the Unión Obrera de la Construcción de la República Argentina (UOCRA), which is the construction workers’ union. Large unions, like UOCRA, have their own hospitals and providers that care for workers and their families.

Construir Salud: Obra Social Del Personal De La Construcción
(Hospital for the construction workers)

There are basic mandatory health services required by law that the insurance plans must cover. Employers provide health insurance, but employees can pay extra for a better plan. The government funds obras sociales for retirees and their families, through the Programa de Atención Médica Integral (PAMI), a Comprehensive Medical Attention Program. Did I mention acronyms are just as popular in Argentina?

Private

There are modern private healthcare facilities in urban areas that provide high quality care. Middle and upper class citizens pay for their insurance. Private insurance plan prices are determined by age and pre-existing conditions. There is a new law that everyone can get insurance with pre-existing conditions, but they will pay more. Argentina has higher rates of tobacco use than the United States, but smoking doesn't affect insurance. There is flexibility to move within the system; many people with private insurance utilize the public providers for surgeries and immunizations. Rare surgeries are provided in public hospitals with no bill or debts, but greater wait times. Pregnant women and children under one year of age receive free care, paid for by the government.

On the best insurance plans, you can get one cosmetic plastic surgery every year. Plastic surgery is common and affordable in a country obsessed with looking young, thin and beautiful; retail stores do not sell plus size clothing. Argentina has become a medical tourist destination for plastic surgery.

Providers

The public system has good doctors, but nursing is not professionalized. There is a shortage of people studying nursing because people think of them as maids in public hospitals. Public facilities have prestige as learning hospitals, so doctors want to work there, but they are not paid well. Public doctors are considered middle class citizens, so they usually work half days in public system and have a second job in the private system. There is a shortage of general practitioners in Argentina as most doctors are specialized. Patients don't need referrals; there is direct access to specialty care. Doctors use paper medical records and prescriptions are handwritten.

The wages in rural areas are three times lower than in urban areas. Doctors don't want to work in rural areas because they are not challenged. Rural doctors work in family practice clinics and it is common for people travel to a big city for major health issues. The rural population has lower standards of living, poorer health, more poverty, and higher school dropout rates.

Results-Based Financing

The 2001 economic crisis in Argentina resulted in a rise in the number of vulnerable people without health coverage and increased poverty. Health indicators, including child and maternal mortality rates, deteriorated in the poorest regions, and national averages worsened. This gave the government the opportunity to strengthen its role in the decentralized, provincial health services.

Plan Nacer, Argentina’s Provincial Maternal and Child Health Investment Program, was introduced in 2004. The program was aimed at increasing access to basic health services to address the causes of maternal and child mortality for uninsured pregnant women and children under six years old. The Plan Nacer program is publically funded and supports the introduction of highly innovative results-based financing mechanisms at the national, provincial and provider levels. The objectives were to reduce infant mortality and to modify the dynamics of financing health services.

The program increased the probability of a first prenatal care visit before week 13 and week 20 of pregnancy. The number of prenatal visits increased, and women also benefited from an improved quality of care, measured by increases in the likelihood of vaccinations and ultrasounds. The improvement in the quantity and quality of services translated into healthier births, an increase in average birth weight, and a decrease in the likelihood of children being born with very low birth weight. Finally, for children under age five, the program raised the likelihood of well-baby checkups.

The Plan Nacer introduced results-based financing mechanisms that promoted a new incentive framework for financing and providing health services that rewards providers for increased healthcare coverage, delivery, and staff productivity. This demonstrates movement away from the traditional healthcare system based on inputs and fixed budgets toward one geared at outputs and results. This is a promising incentive model that could be used by the rest of the world. Lessons from the successful Plan Nacer program can be used to strengthen any public health system.

Sources:
Cortez, R., & Romero, D. (2013). Argentina: Increasing utilization of health care services among the uninsured population. Washington, D.C.: World Bank. https://openknowledge.worldbank.org/bitstream/handle/10986/13289/749560NWP0ARGE00Box374316B00PUBLIC0.pdf?sequence=1